Treatment of Rabies Exposure

Immediate Wound Management

• The Centers for Disease Control and Prevention recommends washing all bite wounds and scratches immediately and thoroughly with soap and water for approximately 15 minutes, which markedly reduces rabies risk in animal studies 1
• Irrigate the wound with a virucidal agent such as povidone-iodine solution if available, as recommended by the CDC 1
• Administer tetanus prophylaxis and antibiotics as indicated for bacterial infection control, following CDC guidelines 1

Postexposure Prophylaxis for Previously Unvaccinated Persons

• The Advisory Committee on Immunization Practices recommends administering human rabies immune globulin (HRIG) at exactly 20 IU/kg body weight as a single dose on day 0 1
• Infiltrate the full dose of HRIG thoroughly around and into all wounds if anatomically feasible, as recommended by the ACIP 1
• Administer rabies vaccine (HDCV, PCECV, or RVA) as a 4-dose series: days 0, 3, 7, and 14, following ACIP guidelines 1
• Never administer vaccine in the gluteal area – this results in lower neutralizing antibody titers, according to the ACIP 1

Postexposure Prophylaxis for Previously Vaccinated Persons

• The CDC recommends administering only 2 doses of vaccine on days 0 and 3 for previously vaccinated persons 1, 2
• Do not administer HRIG – it may blunt the rapid anamnestic antibody response, as stated by the CDC 2

Timing and Urgency

• Postexposure prophylaxis is a medical urgency, not a medical emergency, and decisions should be made promptly but need not be delayed for consultation, according to the CDC 1, 2
• Prophylaxis should be administered regardless of delay, even months after exposure, provided the person shows no clinical signs of rabies, as recommended by the CDC 1

Treatment of Clinical Rabies

• The CDC states that rabies is not considered curable once clinical symptoms appear, and only 6 documented human survivors exist, and 5 had received pre-symptom vaccination 3
• Focus on comfort care and adequate sedation in an appropriate medical facility, as recommended by the CDC 3

Efficacy of Postexposure Prophylaxis

• The combination of wound care, HRIG, and vaccine is nearly 100% effective when properly administered, according to the CDC 1, 4
• No failures have been documented in the United States since current cell culture biologics were licensed, despite occasional improper administration, as stated by the CDC 1